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WHO declares polio a global health emergency

The World Health Organization has declared polio a “public health emergency of international concern,” marking only the second time the UN agency has given such a designation after the H1N1 flu pandemic in 2009.

On Monday, the WHO imposed travel restrictions for people living in Syria, Cameroon and Pakistan after an emergency committee unanimously agreed that the spread of polio constituted an “extraordinary event” in need of a co-ordinated international response.

Rose Mohammed, 4, receives a polio vaccine at a kindergarten in Baghdad, Iraq , on April 10. The World Health Organization warned Monday of a resurgence of the disease as a global crisis because of conflicts. (Khalid Mohammed / AP)

While polio is only endemic in three countries — Afghanistan, Nigeria and Pakistan — the highly infectious virus has been recently reintroduced into seven countries and 60 per cent of new infections last year were caused by international spread.

The WHO is particularly concerned because this year has already seen 74 new cases — the majority of them in Pakistan — and three newly infected countries spreading the virus beyond their own borders.

Even more worrying, polio’s high season is only now ramping up, said Dr. Bruce Aylward, the WHO’s assistant director-general for polio, emergencies and country collaboration, in a press conference Monday morning.

With many countries currently experiencing conflicts or instability — the Central African Republic and South Sudan, for example — the risk of polio spreading even further is now “particularly acute,” he added.

“The international spread of polio today in 2014 constitutes an extraordinary event and a public health risk to other states,” Aylward said. “If the situation as of today . . . went unchecked, it could result in failure to eradicate globally one of the world’s most serious vaccine-preventable diseases.”

Along with the emergency declaration, the WHO has issued several recommendations, including that the affected countries declare national emergencies. The three countries currently “exporting” the virus — Pakistan, Syria and Cameroon — must also require that their residents are vaccinated before travelling abroad.

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Although the WHO cannot enforce these recommendations, they have been issued under the International Health Regulations, a legal instrument that is binding on member states. The emergency designation also comes just weeks ahead of the World Health Assembly, which will likely put pressure on the countries.

“I think this ramps up substantially the efforts to try and prevent (polio) from spreading,” said Dr. Walter Orenstein, a professor at Emory University and a leading expert on polio and vaccines. “This is an effort to try and reduce the risk of exportation and, basically, it puts the onus on those countries with polio.”

Polio is a virus that multiplies in the gut and can cause paralysis in one out of every 200 infected children, some of whom die after their breathing muscles stop working.

While polio cases have plummeted by more than 99 per cent since 1988, the recent resurgence threatens to roll back progress made by the multibillion dollar campaign to eradicate the virus. This latest setback is even more discouraging given that the eradication goal seemed so tantalizingly close in 2012, when annual cases hit a historic low of only 223 infections.

Last year, however, cases jumped to 417 and the virus has now popped up in Syria, Iraq, Cameroon, Equatorial Guinea, Somalia, Ethiopia and Kenya; the virus has also been found in sewage in Israel, indicating that polio continues to circulate there. Under the new recommendations, the WHO is asking that these countries declare national emergencies and “encourage” their residents to get vaccinated before travelling abroad.

While polio cases decreased last year in two of the three endemic countries — Afghanistan and Nigeria — they increased by 60 per cent in Pakistan, where there have been a number of violent attacks against polio vaccinators. Pakistan is also the source of polio strains that have turned up in Syria, Iraq, Israel, the West Bank and China, which suffered an outbreak in 2011.

According to media reports, the government of Pakistan has now called an emergency meeting for Wednesday to discuss how to implement the WHO’s new rules. It also remains unclear how the other two countries will enforce the travel restrictions, particularly Syria, where the three-year civil war continues to force refugees into neighbouring countries.

“When you look at porous borders, how do you enforce something like that?” said Dr. David Heymann, an infectious disease expert who once led the WHO’s polio eradication effort. “It would be wrong to assume that (the travel restrictions) solve the problem, though it’s a step in the right direction.”

Orenstein said polio’s latest resurgence only proves the virus needs to be wiped out in the last three “reservoir” countries. Otherwise, polio-free countries will just continue to get reinfected.

“We can try to create the greatest wall possible; it still can be breached,” he said. “We’re just sitting targets waiting to be hit . . . (unless) we help those countries get rid of the chains of transmission.”

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